Healthcare Provider Details

I. General information

NPI: 1487105482
Provider Name (Legal Business Name): NATIVE PROJECT PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/14/2016
Last Update Date: 10/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1803 W MAXWELL AVE
SPOKANE WA
99201-2831
US

IV. Provider business mailing address

1803 W MAXWELL AVE
SPOKANE WA
99201-2831
US

V. Phone/Fax

Practice location:
  • Phone: 509-325-5502
  • Fax:
Mailing address:
  • Phone: 509-325-5502
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332800000X
TaxonomyIndian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy
License Number601182805
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number601182805
License Number StateWA
# 3
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number601182805
License Number StateWA

VIII. Authorized Official

Name: TONI LODGE
Title or Position: CEO
Credential:
Phone: 509-325-5502